Matthew R Misner, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

02004768A Issued in IN

Practice address

213 Middlebury St
Goshen, IN 46528

Phone

(574) 534-3300

Fax

(574) 534-5412

NPI assigned

Sep 11, 2007

Last updated

Aug 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Dr. Matthew Robert Hannasch Former name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hospice/Palliative CareAlso: Pediatric Medicine

Education

Lake Erie College of Osteopathic Medicine, Erie, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for Medical Services LLCGroup PAC ID 0042603599, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Center for Hospice and Palliative Care Inc, the Hospice, Mishawaka, IN, CCN 151501

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmisner2931196@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Center for Medical Services LLC

  • General Practice Physician
  • Mishawaka, IN
  • NPI 1700544509
  Medicare reassignment Care Compare group NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc

  dba Saint Joseph Regional Medical Center-South Bend Campus Inc Mobile Med

  • Mobile Mammography Clinic/Center
  • South Bend, IN
  • NPI 1023844693
  Medicare reassignment NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc

  • Critical Care Medicine (Internal Medicine) Physician
  • Mishawaka, IN
  • NPI 1699132365

  Pediatrics

  NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  NPD
• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  dba Saint Joseph Foot and Ankle Sports Medicine Institute Plymouth

  • Family Medicine Physician
  • Plymouth, IN
  • NPI 1538585187

  Pediatrics

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Center for Hospice and Palliative Care, Inc

  dba Center For Hospice Care

  • Community Based Hospice Care Agency
  • Mishawaka, IN
  • NPI 1720131543
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1366637555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-3300",
            "fax_number": "574-534-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "46528",
            "telephone_number": "574-534-3300",
            "fax_number": "574-534-5412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6913 N Main St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308039",
            "country_code": "US",
            "telephone_number": "574-647-4540",
            "fax_number": "574-647-2567",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "808 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465287100",
            "country_code": "US",
            "telephone_number": "574-534-0088",
            "fax_number": "574-971-8434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISNER",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-11",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A11818",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102205035",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "4644",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "02004768A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300019274",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MATTHEW",
            "last_name": "HANNASCH",
            "middle_name": "ROBERT",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer A Miller, MSW, LCSW
• Justine Brook Miller, MA, RDN, CD
• Karissa Miller, MSW
• Leah R Miller, N.P.
• Lexi Miller, DC
• Amy Jo Moore
• David Moore, LCSW
• Emily Marie Moore, N.D.
• Janice Moore, CRNA
• Julie Ann Moore, PMHNP

• Pediatrics Physician in Goshen, IN
• Providers in Goshen, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.